Noted
The counsellor, via their legal representation, outlines the existing procedures for information sharing, including obtaining client consent, and emphasises the limitations faced by private practitioners. (AI summary)
View full response
Dear Mr Sigee Inquest into the death of Sam Spooner I act for Mrs upon instructions from her Insurers and have been instructed in this matter since you issued your Report into Preventing Future Deaths (dated 8.11.19). I have been asked to assist Mrs
with a response to your Report and, in particular, your concerns as below:-
1) There was a lack of multi-agency information sharing cooperation, coordination and effective communication both within and between healthcare providers which meant that: a) The private counsellor who provided treatment to Mr Spooner did not have adequate information from other health care providers as to his medical/mental health history, diagnosis and treatment by other healthcare professionals. b) There was a failure to adopt an effective multi-agency approach to the care for Mr Spooner from 20 August 2018 when it was known that he was actively considering ending his life. c) There was a failure to adequately intervene from 30 August 2018 when it was known that: i) Mr Spooner had recently attempted to take his life; and ii) Mr Spooner had subsequently undertaken additional research and made further preparations to enable him to do so.
2) There was an excessive and unreasonable reliance placed upon Mr Spooner's family by health care providers to keep him safe when those providers knew that Mr Spooner's family were not in a position to do so. Health care providers lacked awareness and/or failed to adequately involve other agencies who may have been able to keep Mr Spooner safe, for example the police who may have been able to exercise their powers under section 136 of the Mental Health Act 1983 to take Mr Spooner to a place of safety.
Mr Peter Sigee 31 January 2020 2 68592294-1 You have asked that any response from Mrs must contain details of actions taken or proposed to be taken, setting out the timetable for action. Otherwise, we must explain why no action is proposed. It may be helpful if I set out some of the factual background to this matter. Mrs was unrepresented at this Inquest and this is the only inquest which she has ever attended. She works entirely privately as a psychotherapist and as a private practitioner, never has access to clients' clinical records, detailed (or sometimes any) mental health history or any other psychiatric evaluations or input. In this case, the situation was even more difficult because Mrs had only seen Mr Spooner twice, on 21 August 2018 and then on 30 August 2018. It was Mr Spooner's mother who arranged for Mr Spooner to have private counselling with Mrs . She understood that Mr Spooner's mother did not consider that the input he was receiving from the NHS was helping him. As to the nature of the input which Mr Spooner was receiving from NHS Mental Health Services, Mrs had no information whatsoever, nor did she have any direct access to Mr Spooner's GP or any records of his treatment, either GP or mental health. In these circumstances, any information which Mrs had in relation to Mr Spooner was taken either directly from him or from his mother, to whom she spoke over the phone when she first made contact and with whom she also had some text dialogue. The priority for Mrs in these two initial sessions was to establish a rapport with Mr Spooner, but the therapeutic process is just that and this was the beginning of a process in which she hoped to establish a relationship with, and hopefully help, Mr Spooner. In the initial session, Mr Spooner made it clear that he did not want to be there. Mrs found it difficult to engage with him, which meant that taking any information from Mr Spooner in those circumstances was very difficult indeed. Mrs shares the Coroner's concerns about the outcome in this case and was extremely saddened to hear that Mr Spooner had indeed committed suicide the day after she saw him. Mrs was unaware of the extent of Mr Spooner's interaction with NHS Mental Health Services until she heard the evidence herself at the Inquest. She has taken the opportunity to investigate in some considerable detail the options available to her as a private psychotherapist in these circumstances. It should be made clear that this is not a situation which Mrs has encountered in the past. She has spoken to other private psychotherapists and her Clinical Supervisor about their respective practices. Mrs always asks clients whether they have ever been under Mental Health Services, but she has now amended her assessment and consent forms (which are attached) so that she asks more particular questions about previous psychiatric history. It is also the case that NICE issued guidelines on 10 September 2019 (i.e. after Mr Spooner's death) in relation to multi-agency suicide prevention partnerships and Mrs has both considered those guidelines and thought about how she might implement some changes in her practice, both as a result of those guidelines and as a result of this case. Mrs has included a specific question on her consent form, if the client indicates that they have been under the care of a mental health practitioner, to ask for the client's consent to contact that mental health practitioner. Her intention in so doing is to establish contact with the NHS Mental Health Service, where relevant, in order that she has the ability to have some dialogue with that professional if needs be.
Mr Peter Sigee 31 January 2020 3 68592294-1 Mrs has also made extensive investigations locally to ascertain what the options might have been which were open to her on 30 August 2018 to secure further support for Mr Spooner . Mrs has found some notes from a public engagement event between March and May 2018 which outlines the provision of Adult Mental Health Support Services in Macclesfield, principally via the Millbrook Unit. She has also spoken with as many contacts as she can within the local Mental Health Services and has ascertained a number of telephone numbers for crisis home treatment teams in her immediate area, including the following: The Congleton Crisis Home Treatment Team, although this is not an out of hours service; The Out of Hours Mental Health Support Service for East Cheshire, based in Macclesfield, which is open from 5pm to 9am; The Community Mental Health Team in Macclesfield; The Crewe Out of Hours Psychiatry Service. Mrs considers that she is now much more informed about local mental health services and, should these events arise again, she would be in a better position to deal with a similar scenario. In terms of the engagement with the GP, Mrs believes that it was appropriate to contact the GP who is the route into an NHS Mental Health Services referral. She now appreciates that there may be circumstances in which the involvement of the police would be appropriate, given their powers under the Mental Health Act. Mrs has of course taken on board the Coroner's indications in this regard and does bear in mind that, if there were a question of an immediate danger to someone's life because of suicidal ideation, contacting the police may also be an appropriate course of action. Finally, in terms of a practical example of changes in her practice, Mrs has recently dealt with a suicidal client and, on this occasion, in fact drove the client to her GP practice herself because of her particular circumstances. She also engaged directly with the Community Mental Health team, with the client's consent, as well as with the GP's surgery to request a referral for a further Community Mental Health assessment. Much of how she dealt with this client was informed by lessons learned from Mr Spooner's case. We trust this this is of assistance to the Coroner in response to the report but would be of course willing to assist further if the Coroner requires any further information.